Med Surg Exam 2 - Neurosurgical & Neurological Disorders

I = benign through IV = highly malignant

What do the WHO tumor classes mean?

yes (can cause edema that shifts structures, and increases ICP)

Are benign brain tumors problematic?

gliomas

Brain tumors that develop from glial cells

astrocytoma

type of glioma formed from astrocytes

graded I-IV

I = can be treated with craniotomy

What is a class I astrocytoma?

glioblastoma multiforme (class IV)

Most common and fastest growing brain tumor glioma

No cure, average survival is 12-18 months

ependyoma

brain tumor that originates in the lining of the ventricles

usually benign

treated with radiation

meningeal tumor (meningioma)

Brain tumor that arises from the meninges, the layers of tissue covering the brain and spinal cord

Usually slow-growing and often benign

Treated with surgery

lung or breast cancer

Which type of cancers most commonly cause metastatic brain tumors?

biopsy

What is needed for definitive diagnosis of brain tumors?

frontal lobe

A region of the cerebral cortex that has specialized areas for movement, abstract thinking, judgment, and personality

temporal lobe

A region of the cerebral cortex responsible for hearing and language.

parietal lobe

A region of the cerebral cortex whose functions include processing information about touch (sensory).

occipital lobe

A region of the cerebral cortex that processes visual information

cerebellum

A large structure of the hindbrain that controls fine motor skills (coordination)

brainstem

the lower part of the brain that connects the brain to the spinal cord. It controls many basic life functions and acts as a relay center between the brain and the body.

stereostatic surgery

a minimally invasive surgical technique that uses a three-dimensional (3D) imaging system to precisely target specific areas in the brain or other parts of the body. It enables surgeons to reach deep areas with great accuracy, often without making large incisions

no

Can chemo cross the BBB?

biodegradable wafer, ommaya reservoir

How is chemo delivered to the brain?

biodegradable wafer

a small, dissolvable disk that contains chemotherapy drugs. It is placed directly in the brain at the tumor site during surgery, allowing for a targeted release of chemotherapy to treat brain tumors

Ommaya reservoir

a device used to deliver chemotherapy directly into the cerebrospinal fluid (CSF) around the brain and spinal cord. It allows chemotherapy to reach areas of the central nervous system (CNS) that might otherwise be difficult to treat due to the blood-brain barrier

increased ICP, infection, sodium imbalances, intracranial hemorrhage, seizures, DVT/PE, gastric ulcer, cognitive dysfunction

What are some complications of brain tumors?

craniotomy

part of the skull is removed to access the brain

ultrasound, stereotaxy, endoscopic/keyhole surgery, cortical mapping, neurendoscopy

What are some ways that craniotomy surgery is guided?

endoscopic/keyhole surgery

a hole is made into the skull of through the lip or nose so that endoscopic instruments can be used for the procedure

cortical mapping/somatosensory evoked potentials

language, motor, and sensory areas of the brain are identified during surgery through EMG, somatosensory response, and direct stimulation

transsphenoidal hypophysectomy

endoscopic procedure to surgically remove a pituitary tumor through an incision in the sphenoid sinus without disturbing brain tissue

do not remove (sometimes made from fat from abdomen or thigh)

What is important nursing care for nasal packing after a transsphenoidal hypophysectomy?

CSF lead, pneumocephalus

What are some complications of transsphenoidal hypophysectomy?

blood stain surrounded by a yellowish stain; highly suggestive of a cerebrospinal fluid leak

What is a "halo sign"?

avoid blowing nose, coughing, sneezing, drinking with a straw, bending over, or straining for 4 weeks

What is an important teaching for a patient after a transsphenoidal hypophysectomy?

must take hormone replacements for life

What does a patient need to know if they had their entire pituitary gland removed?

place a dressing and turn to the side of the leak

What should you do if your patient has a CSF leak from their ear?

place a dressing under their nose

What should you do if your patient has a CSF leak from their nose?

suction nose or use nasal packing, put fingers in the nose or ears

What should you not do if a patient has a CSF leak from their nose or ears?

encourage participation in care and rehab

What is an important psychological teaching for a patient after neurosurgery?

hemorrhagic stroke

when a blood vessel in the brain bursts, causing bleeding (hemorrhage) in or around the brain. This bleeding increases pressure on brain tissue, leading to cell damage and loss of brain function

brain tumors, aneurysms, arteriovenous malformations, traum

What are some causes of hemorrhagic stroke?

anticoagulant use

What is a major risk factor for hemorrhagic stroke?

intracranial aneurysm

weakening of the vessel wall causes dilation or ballooning, which may rupture or put pressure on surrounding brain tissue

subarachnoid space

Where do intracranial aneurysms primarily rupture?

HTN, smoking, ETOH use, females, congenital weakness in vessel walls, genetics

What are risk factors for intracranial aneurysms?

rupture or vasospasms

What are the major issues that can occur from an intracranial aneurysm?

sudden, severe headache (thunderclap headache), nuchal pain and rigidity, photosensitivity

What are clinical manifestations that an intracranial aneurysm has ruptured?

CT

What is the primary diagnostic test for intracranial aneurysms?

yellow-ish (color change occurs as red blood cells break down in the CSF, releasing hemoglobin and causing a yellow hue)

What does the CSF from an LP on a patient with a ruptured intracranial aneurysm look like?

control hypertension (very important), treat electrolyte abnormalities (hypo-natremia, calcemia, kalemia, and magnesemia), stool softeners, analgesics (limit narcotics)

How are intracranial aneurysms treated with medicine?

clipping or coiling

How are intracranial aneurysms treated surgically?

aneurysm clipping

surgical method to isolate an aneurysm from the rest of the circulatory system by placing a small clip across its neck

aneurysm coiling

Placement of catheter via femoral artery to area of aneurysm. Multiple small coils are placed/packed eventually leading to clot formation preventing continued bleeding

delayed cerebral ischemia

a condition where blood flow to the brain is reduced, typically occurring 5-9 days after a subarachnoid hemorrhage (SAH) due to a ruptured aneurysm. Reduced blood flow can lead to brain tissue damage and neurological decline

the excess calcium from hemorrhaged blood irritates the vessels and cause vasospasms or just by inflammation

What are the causes of delayed cerebral ischemia?

change in LOC and new neuro deficits

What are the causes of delayed cerebral ischemia?

nimodipine (calcium channel blocker that can cross the BBB to treat and prevent vasospasms), increase BP to >20mmHg above baseline, angioplasty

What are some ways delayed cerebral ischemia is treated?

arteriovenous malformation

an abnormal tangle of blood vessels connecting arteries and veins in the brain or spinal cord. This tangle disrupts normal blood flow, increasing the risk of bleeding and other complications.

rupture

A complication of arteriovenous malformations is that 40-70% of them _______________.

CT or MRI

How are arteriovenous malformations diagnosed?

surgery, radiation, or embolization

How are arteriovenous malformations treated?

traumatic brain injury (TBI)

a blow to the head or a penetrating head injury that damages the brain

alcohol or drug use, failure to use safety devices (seatbelts/helmets)

What are some contributing factors to TBIs?

acceleration-deceleration TBI

a type of brain injury caused by sudden forward and backward or side-to-side movement of the head. This movement causes the brain to collide with the skull, resulting in damage to brain tissue

head does not collide with another object

coup-countercoup injury

a type of brain injury that occurs when the brain strikes one side of the skull (coup) and then bounces back to hit the opposite side (contrecoup). This causes damage to both the initial impact site and the opposite side of the brain

rotational TBI

when the head experiences a sudden twisting or rotational force, causing the brain to rotate inside the skull. This rotational movement stretches and shears brain tissue, particularly the nerve fibers (axons) that connect different brain regions

penetrating TBI

when an object, such as a bullet, knife, or shrapnel, pierces the skull and directly damages brain tissue. This type of injury can cause localized and severe brain damage

0-30 mintues

For a mild TBI, how long are there LOC changes?

30 min - 24 hours

For a mild moderate, how long are there LOC changes?

>24 hours

For a severe TBI, how long are there LOC changes?

a moment up to 24 hours

For a mild TBI, how long is there alteration of consciousness/mental state change?

>24 hours

For a moderate or severe TBI, how long is there alteration of consciousness/mental state change?

post-traumatic amnesia (PTA)

a state of confusion and memory loss following a traumatic brain injury (TBI). The person may not remember the accident or events after it, and they may have difficulty forming new memories

0-1 day

For patients with mild TBIs, how long can PTA last?

1-7 days

For patients with moderate TBIs, how long can PTA last?

>7 days

For patients with severe TBIs, how long can PTA last?

13-15

What is the GCS score of a patient with a mild TBI?

9-12

What is the GCS score of a patient with a moderate TBI?

<9

What is the GCS score of a patient with a severe TBI?

primary brain injury

brain injury that is a direct result of the initial injury

sutures, staples, or glue

How are scalp lacerations treated?

depressed skull fracture

type of skull fracture where a portion of the skull is pushed inward toward the brain due to trauma, often from a direct blow or impact to the head. The fracture can cause the bone to press against the brain tissue, leading to potential injury

meningitis

What condition is a patient at an increased risk for if they have a depressed skull fracture?

basilar skull fracture

a break in the bones at the base of the skull, often involving the bones around the brainstem, inner ear, and the cervical spine

patient must not blow nose, no NG or nasotracheal tubes, no BiPAP (the bones to stop air/foreign objects from going into brain is broken)

Which things must be avoided if a patient has a basilar skull fracture?

Battle's sign, raccoon eyes

What are two signs of a basilar skull fracture?

Battle's sign

Bruising behind the ears, indicative of a basilar skull fracture

raccoon eyes

Bruising around the eyes, indicative of a basilar skull fracture

concussion

a mild traumatic brain injury (TBI) that results from a blow or jolt to the head, causing the brain to move within the skull. It can temporarily affect brain function, including cognition, balance, and memory

brain rest (no hard "thinking," dark room)

What is the treatment for concussions?

short-term memory loss, HA, decreased attention, dizziness, irritability, difficulty with executive functioning, emotional lability, nausea

What are some manifestations of a concussion?

post-concussion syndrome

lingering symptoms from a concussion that last for an extended period of time (for a week up to a year)

amitriptyline

Which medication is used to treat headaches associated with post-concussion syndrome?

brain contusion

brain tissue bruise

cerebral edema can cause increased ICP 24-72 hours post injury

What is a complication of brain contusions?

epidural hematoma

a collection of blood between the skull and the dura mater

arterial (bleed very quickly - can rapidly expand and cause herniation)

Are epidural hematomas caused by arterial or venous bleeds?

6-8 hours

How quickly do epidural hematomas reach their peak size?

"Talk and die syndrome" (patients seem normal for neuro assessments then rapidly decline)

Epidural hematomas are also called:

15-20%

What percentage of epidural hematomas are fatal?

subdural hematoma

a collection of blood between the dura mater (the outer layer of the brain's protective covering) and the arachnoid mater (the middle layer). It typically results from a tear in the veins that drain blood from the brain to the dural sinuses, causing blood to pool in the subdural space

venous (slower bleeding)

Are subdural hematomas caused by arterial or venous bleeds?

24-48 hours post trauma

When do acute symptoms of a subdural hematoma show?